Brachial Plexopathy After Cervical Spine Surgery

Than, Khoi D.; Mummaneni, Praveen V.; Smith, Zachary A.; Hsu, Wellington K.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

doi:10.1177/2192568216687297

Cited by 12 publications

(7 citation statements)

References 7 publications

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“…Parsonage-Turner syndrome (PTS), otherwise known as idiopathic brachial plexopathy or neuralgic amyotrophy, is characterized by a sudden onset of pain, which can be accompanied by neuropathic characteristics in the neck, shoulder, and arm [2]. After some hours or even days, patients often develop motor weakness with or without sensory abnormalities [2,13]. The motor symptoms generally involve the upper brachial plexus and a winging scapula is found in about half of the cases [13].…”

Section: Parsonnage-turner Syndromementioning

confidence: 99%

“…Similar to C5 palsy, CT myelogram, or an MRI is necessary to rule out neural compression. Another clinical characteristic that may raise the suspicion of PTS is that muscle weakness, sensory changes, and pain does not necessarily involve the same nerve root or peripheral nerve distribution [2,13]. Pain is generally unaltered by the neck or arm movement.…”

Section: Parsonnage-turner Syndromementioning

confidence: 99%

“…Nerve root injuries secondary to cervical spine surgeries are still infrequent but much more common. Postoperative C5 palsy, Parsonage-Turner syndrome (also known as idiopathic brachial plexus neuropathy or neuralgic amyotrophy), C8-T1 radiculopathy, and Horner's syndrome are potential complications of cervical spine procedures [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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Post-operative nerve injuries after cervical spine surgery

Joaquim

Makhni

Riew

2018

International Orthopaedics (SICOT)

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Although relatively rare, post-operative nerve injuries may occur after cervical spine procedures. The most common postoperative neural disorder is C5 nerve palsy. The risk factors for C5 nerve palsy are male gender, OPLL, and posterior cervical approaches. It generally presents with deltoid and/or biceps weakness, and may present immediately or several days after surgery. Treatment is generally conservative due to transient duration of symptoms, but evaluation of residual compression at C4-5 is essential. PTS (Parsonage-Turner syndrome) is an idiopathic plexopathy generally presenting with severe neuropathic pain in the shoulder, neck, and arms, followed by neurological deficits involving the upper brachial plexus. The deficits typically present in a delayed fashion after the onset of pain. Once residual nerve compression is ruled out, initial treatment is based on pain control and physical therapy. Post-operative C8-T1 nerve palsies occur with weakness of the five intrinsic muscles of the hand innervated by the medial nerve, with sensory symptoms in the territory innervated by the ulnar nerve (ulnar two digits of the hand), and also the medial forearm. The risk factors for C8-T1 nerve injuries after surgery are C7 pedicle subtraction osteotomies and posterior fixation of the cervico-thoracic junction, especially in patients with preoperative C7-T1 stenosis. A wide foraminal decompression at C7-T1 region is necessary to minimize risk of this complication. Finally, Horner's syndrome can occur post-operatively, especially after anterolateral approaches to the middle and lower levels of the cervical spine. It is characterized by ipsilateral papillary miosis, facial anhydrosis, and ptosis secondary to injury of the cervical sympathetic nerves. Avoid using the cautery on the lateral border of the longus colli muscle, where the sympathetic chain lies and place the retractors properly underneath the muscle to decrease the chance of sympathetic injuries. It can also occur from iatrogenic compression or injury to the T1 nerve root, as the sympathetic chain gets some of its fibers from that level. Understanding the most common potential nerve injuries after cervical spine procedures is helpful in prevention, early diagnosis, and appropriate management.

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Section: Parsonnage-turner Syndromementioning

confidence: 99%

Section: Parsonnage-turner Syndromementioning

confidence: 99%

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Post-operative nerve injuries after cervical spine surgery

Joaquim

Makhni

Riew

2018

International Orthopaedics (SICOT)

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“…This occurs with an incidence of 1%. The incidences of other known complications with ACDF are as follows: esophagus lesion 0.25% [5], infection 0.1-1.6% [6], injury to the recurrent laryngeal nerve 0.6-2.9% [7], injury to the superior laryngeal nerve 0-1.25% [8], injury to the hypoglossal nerve 0-1.28% [9], vertebral artery injury 0.08% [10], dural tear 0.5-3.7% [11], spinal cord injury 0-0.24% [12], Horner's syndrome 0.06% [13], brachial plexus injury 0.1% [14], C5 palsy 0-2.5% [15], and injury to the thoracic duct 0.08% [16].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial

Holy

MacDowall

Sigmundsson

et al. 2021

Trials

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Background Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50–55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF) Methods A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as “active control.” The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years. Discussion Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation. Trial registration ClinicalTrials.gov NCT04177849. Registered on November 26, 2019

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“…6 Neurophysiological positioning injuries have decreased with the use of monitoring equipment such as somatosensory-evoked potential (SSEP), or transcranial electrical motor-evoked potential monitoring (TCeMEP). 7 Guidelines from the American Operating Room Nurses (AORN) association indicate that OR staff responsibilities include monitoring patient positioning during surgery and making any necessary changes. 6 When an SSEP or TCeMEP indicates altered neural function secondary to surgical positioning, the OR staff then modifi es the patient's position to mitigate neural damage.…”

Section: Introductionmentioning

confidence: 99%

Defining Practices to Avoid Hospital-Acquired Pressure Injuries in the Operating Room

Creehan¹,

Black²

2022

Journal of Wound, Ostomy &Amp; Continence Nursing

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BACKGROUND : Data from the Agency for Healthcare Research and Quality indicate that hospital-acquired pressure injuries (HAPIs) and surgical site infections are the only 2 hospital-acquired conditions that have not improved. Consequently, health systems around the nation are struggling to lower HAPI rates and avoid penalties. All patient care areas of the hospital play a part in pressure injury (PI) development. Analysis of real-time PI data and completion of root cause analysis related to HAPIs can guide organizational leaders to specifi c clinical areas in need of improvement. Surgical patients are high risk for development of a PI due to their unique vulnerability from multiple transfers and induced immobility. Operating room (OR) nursing organizations and wound care professional organizations have published evidence-based clinical practice guidelines addressing prevention of PIs in the OR. CASES: This article discusses 2 surgical patients from 2 different academic medical centers who experienced OR-associated HAPIs. Operating room HAPI prevention measures should include current evidence-based practice recommendations. Each hospital should take a critical look at their OR HAPI prevention procedures and measure them against the current published guidelines, changing and updating them to refl ect best practices for avoiding PI development. Clinicians from both the OR and WOC nurse team can provide expertise to develop confl uent nursing practice standards for OR-associated HAPI reduction. CONCLUSION : This article highlights the commonalities found in the guidelines and encourages collaboration between WOC nurses and OR nurses in building and implementing pressure injury prevention practices associated with the OR.

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Brachial Plexopathy After Cervical Spine Surgery

Cited by 12 publications

References 7 publications

Post-operative nerve injuries after cervical spine surgery

Post-operative nerve injuries after cervical spine surgery

Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial

Defining Practices to Avoid Hospital-Acquired Pressure Injuries in the Operating Room

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